25 Applications & Permits THE COMMONWEALTH OF MASSACHUSETTS
Nsa./±-3
BOARD OF HEALTH OF'
Appliratiun fur disposal ruur'k/s (llunstrurtiun Vrrmit
Application is hereby made for a Permit to Construct ' ) or Repair ( ) an Individual Sewage Disposal
System at: f
(
or Let No.
Address
Address
Size Lot Sq. feett
Type of Building 3 Expansion Attic ( ) Garbage Grinder (J-1
Dwelling Type of Bedroom s No. of persons Showers ( ) — Cafeteria ( )
Other—Type of Building
Other fixtures Si.; .G gallons.
Design Flow .5. gallons per person per day. Total daily flow
/ Wit% Diameter Depth
Septic l Tr -Liquid capaoty4C�L..galthns Length Total leaching arena Q d...sq. ft.
Disposal Pit No-No eVidth_. .-�� Depth below role -� Total leaching area 7 sq. ft.
Seepage Pit No Diameter Depth below inlet
Other Distribution box (i-/) Dosing tank ( ) Date
Percolation Test Results Performed by Depth to ate water
Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit Depth g
Description of Soil
Nature of Repairs or Alterations—Answer when applicable
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has issued by the board of h th. G ) /
Signed Z� !
Application Approved By "" ' 0 !J
Application Disapproved for the following reasons
Permit No.-.11.9. `-'
p Date
Issued %L(f y.._.1T.1.)
ate'
No.........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
c/TY OF rVa,.724./ Ineart/
Application far EBiupooal Marko Cnunotrurtiou Permit
Application is hereby made (or a Permit to Construct ( ) or Repair ( ) an individual orwage Disposal
4425
F RI
System at:
0 "O o,ile' EL t47/re4z
Lc.noe•Addres.
>I&ICI1 -YssgiL/s
Owver
Installer
Type of Building
Dwelling—No. of Bedrooms No. of persons
Other--Type of Building
Other fixtures
Design Flow Ci.. .gallons per person per day. Total
Width
Septic Disposal Tr nc Liquid capacit Q�.�-gidthns Length Total Length
Width
age Trench No —No. Depth below inlet
Seepage Pit No Diameter Dosing tank ( )
Other Distribution box ( )
Percolation Test Results Performed by.y-L!<!!T ` '`''Ge" 6
Test Pit No. 1_.._I.:._.minutes per inch Depth of Test Pit
Test Pit No. 2..._._ _minutes per inch Depth of Test Pit
Lot Nu. 62✓/LLE
f(ou,,vTN/s• sl" : /fq,YP
Address
Address
Size Lot cr Garbage Grinder l A feet
Expansion Expansion Attic ( )
Showers ( ) _ Cafeteria ( )
daily flow S.Q.d gallons.
Diameter.__.____. Dej th
Total leaching area / as, .sq. ft.
Total leaching area sq. ft.
�1a Date 9//u„(..>L_.____.
�/ Depth to ground water...S. ..
Depth to ground water
Description of Soil
.Cain 9 F///F '/hvQ 3�z ��. S/LTD/ SSryp /
_COq.PSE sywo
Nature of Repairs or Alterations—Answer when applicable
The undersigned agrees to install the aforedeseribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health
Signed
Application Approved By
Application Disapproved for the following reasons
Date
Date
Permit No
Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
anti* t of (/p1411n1UP
THIS IS,fL7 CERTIFX, That the Individual Sewage Disposal System constructed 1{/ ) or Repaired ( )
by {......env Iva,lyr, ^n a'f
dated...Code as 2 ibed in
has been installed in accordance with the provi�ons of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No sBE CONSTRUED
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C AS A GUARIi ITEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. '"Th ,. .
Inspector..::.. 2- .
- 1 ---_ .... . r:=- }
DATE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF FEE,
No c
%yoga nrks,tllnnstrurtinn flrrmit
ra,
Permission ereby granted Individti(� eryge Disposal System
to Construct ) or Repair ( , ) :?n - ?S i_a qj yp/.4ca
at No
street
Rated._,.'...
t No
as shown on the application for Disposal Works�bnstruction Perth --"-
' 'gaar6>of Healfli
DATE.-............... _ ... . .._ .
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS